Switching from the transrectal to the transperineal route: A single center experience.

INTRODUCTION: This study aimed to evaluate the feasibility of switching from transrectal to transperineal prostate biopsy (TPPBx) by urologists with no previous experience with TPPBx. Material A monocentric clinical study with exhaustive and consecutive inclusions was conducted between January and November 2021, including 105 consecutive patients who underwent TPPBx performed by two senior urologists with no previous experience of TPPBx (GR, FB). Biopsies were performed under local anesthesia (LA) without antibioprophylaxis. The main objective was to assess the safety of this procedure. Adverse events were classified according to the Clavien-Dindo score. The secondary objectives were to assess the level of pain experienced during the different steps of the procedure using a numerating rating scale (NRS), the rate of clinically significant prostate cancer (csPCa) detected, and the level of anxiety using the Hospital Anxiety and Depression Scale (HAD). RESULTS: No major complications (Clavien-Dindo score≥3) were reported. One patient presented with acute urinary retention (1%) and a urinary tract infection (1%). Other adverse events were hematuria (43%), hemospermia (23%), rectal bleeding (1%), perineal hematoma (3%), persistent perineal pain (5%), and de novo erectile dysfunction (2%). The median level of pain on NRS for the procedure was 2.00 (IQ: 1.00-4.00); it was 3.00 (IQ: 2.00-5.00) during LA and 3.00 (IQ: 2.00-5.00) during punctions. In anxious patients (HAD score>10), the level of pain during the procedure was 2.5 (IQ: 2.00-3.00). Overall, csPCa was detected in 63%. CONCLUSION: TPPBx under LA without antibioprophylaxis provides few complications, an acceptable pain threshold, and a satisfactorily rate of csPCa detection, even if performed by urologists with no previous experience of TPPBx.

French AFU Cancer Committee Guidelines - Update 2022-2024: management of kidney cancer.

AIM: To update the recommendations for the management of kidney cancers. METHODS: A systematic review of the literature was conducted from 2015 to 2022. The most relevant articles on the diagnosis, classification, surgical treatment, medical treatment and follow-up of kidney cancer were selected and incorporated into the recommendations. Therefore, the recommendations were updated while specifying the level of evidence (high or low). RESULTS: The gold standard for the diagnosis and evaluation of kidney cancer is contrast-enhanced chest and abdominal CT. MRI and contrast-enhanced ultrasound are indicated in special cases. Percutaneous biopsy is recommended in situations where the results will influence the therapeutic decision. Renal tumours should be classified according to the pTNM 2017 classification, the WHO 2022 classification and the ISUP nucleolar grade. Metastatic kidney cancer should be classified according to the IMDC criteria. Partial nephrectomy is the gold standard treatment for T1a tumours and can be performed by an open approach, by laparoscopy or by robot-guidance. Active surveillance of tumours less than 2cm in size can be considered regardless of the patient's age. Ablative therapies and active surveillance are options in elderly patients with comorbidity. T1b tumours should be treated by partial or radical nephrectomy depending on the complexity of the tumour. Radical nephrectomy is the first-line treatment for locally advanced cancers. Adjuvant treatment with pembrolizumab should be considered in patients at intermediate and high risk for recurrence after nephrectomy. In metastatic patients: Immediate cytoreductive nephrectomy may be offered to oligometastatic patients in combination with local treatment of metastases if this can be complete and delayed cytoreductive nephrectomy can be proposed for patients with a complete response or a significant partial response. Medical treatment should be proposed as first-line therapy for patients with a poor or intermediate prognosis. Surgical or local treatment of metastases can be proposed in case of single or oligo-metastases. The recommended first-line drugs for metastatic patients with clear cell renal carcinoma are the combinations axitinib/pembrolizumab, nivolumab/ipililumab, nivolumab/cabozantinib and lenvatinib/pembrolizumab. Cabozantinib is the recommended first-line treatment for patients with metastatic papillary carcinoma. Cystic tumours should be classified according to the Bosniak classification. Surgical removal should be proposed as a priority for Bosniak III and IV lesions. It is recommended that patient monitoring be adapted to the aggressiveness of the tumour. CONCLUSION: These updated recommendations are a reference that will allow French and French-speaking practitioners to improve kidney cancer management.

Comparison of open and robotic-assisted partial nephrectomy approaches using multicentric data (UroCCR-47 study).

We compared the outcomes of robotic-assisted partial nephrectomy (RPN) and open partial nephrectomy (OPN) using contemporary data to respond to unmet clinical needs. Data from patients included in the registry who underwent partial nephrectomy between January 01, 2014 and June 30, 2017 within 20 centres of the French Network for Research on Kidney Cancer UroCCR were collected (NCT03293563). Statistical methods included adjusted multivariable analyses. Rates of peri- and post-operative transfusion, and of surgical revision, were lower in the RPN (n = 1434) than the OPN (n = 571) group (2.9% vs. 6.0%, p = 0.0012; 3.8% vs. 11.5%, p < 0.0001; 2.4% vs. 6.7%, p < 0.0001, respectively). In multivariable analyses, RPN was independently associated with fewer early post-operative complications than OPN (overall: odds-ratio [95% confidence interval, CI] = 0.48 [0.35-0.66]; severe: 0.29 [0.16-0.54], p < 0.0001 for both) and shorter hospital stays (34% [30%; 37%], p < 0.0001). RPN was also a significantly associated with a decresedrisk of post-operative acute renal failure, and new-onset chronic kidney disease at 3 and 12 months post-surgery. There were no between-group differences in oncological outcomes. In comparison with OPN, RPN was associated with improved peri- and post-operative morbidity, better functional outcomes, and shorter hospital stays. Our results support the use of RPN, even for large and complex tumours.

[Digital transformation of perioperative nurse-coordinated protocols in renal surgery for enhanced recovery and outpatient surgery using UroConnect® application]. / Digitalisation de la coordination infirmière des parcours périopératoires de chirurgie rénale en réhabilitation améliorée et ambulatoire par l'application UroConnect®.

Robot Assisted Partial Nephrectomy (RAPN) is a standard of care for localized renal tumors. It allows a good carcinological control while limiting complications. Despite numerous benefits, the economic sustainability of robotic assistance remains a challenge in the French health care system. The introduction in our institution of two perioperative nurse-coordinated protocols for patients undergoing RAPN (Enhanced Recovery After Surgery: NP-RAAC in 2015 and Outpatient: Ambu-Rein in 2016) is associated with a shortening of the average length of hospital stay, thus reducing the cost of robotic assisted procedures. With the aim of improving efficiency of nursing support within these protocols, we have introduced digitalized nursing coordination by developing a urological perioperative application: UroConnect®. This device is offered to patients by the coordinating nurses during a preoperative visit. It provides information on the pathology and its surgical management. Self-completed questionnaires sent at key moments collect data from the first month after surgery and detect patients presenting difficulties or complications, allowing the nurses to respond with appropriate care. The application allows a secure discharge, a personalised follow-up and an increase in the patient's autonomy and compliance with care.

[Urinary drainage of spinal cord injured patients in the acute phase of trauma: A descriptive, retrospective study]. / Drainage urinaire des blessés médullaires à la phase aiguë du traumatisme : étude descriptive, rétrospective.

INTRODUCTION: Urinary retention in the acute phase of a spinal cord injury (SCI) requires bladder drainage (BD). International scientific societies recommend early implementation of intermittent catheterisation (IC) to prevent lower urological complications, preserve fertility, the urological future of the patient and improve its quality of life. The aim of our study was to analyze the mode of BD in the acute phase of a trauma in patients with SCI. MATERIALS AND METHODS: We retrospectively analyzed the mode of BD of patients with SCI in the acute phase of trauma at the Bordeaux University Hospital from 2013 to 2018. RESULTS: The care pathways of 81 patients were analyzed; patients were hospitalized in intensive care unit (ICU) (42%, n=34), in orthopaedic ward (19.8%, n=16) or in ICU and orthopaedic ward (38.2%, n=31). All of them had an indwelling catheter (IUD) inserted before IC was introduced in 56 of them (69%). On hospital discharge, IC was the BD for only 37% of patients, with differences according to the care pathway: 65% of patients leaving ICU were on IC, compared with 11% leaving orthopaedic ward. 80% of patients who had IC in ICU had an IUD installed in orthopaedic ward. CONCLUSION: In this study, during the acute phase of a trauma in the majority of SCI patient, IC was introduced only in a minority of patients and the promotion was different within the hospital care pathways. Those results enhanced the need for IC awareness in different hospital units to standardize the best patient care. LEVEL OF EVIDENCE: 3.

[Prostatic Urethral Lift under local anesthesia: Single-centre retrospective observational study]. / La pose d'implant UroLift ® sous anesthésie locale : étude observationnelle rétrospective monocentrique.

INTRODUCTION: Urolift implant placement may be preferred to conventional endoscopic surgery for patients who wish to preserve their sexuality or for those who prefer a rapid post-operative recovery. The absence of general anaesthesia is an important element that reinforces the minimally invasive aspect of the procedure and improves the speed of recovery. The aim of this work was to report our preliminary experience of Urolift treatment under local anaesthesia. MATERIALS AND METHODS: A retrospective analysis was conducted including all patients treated with Urolift between 2017 and 2021 in our centre. Local anaesthesia was based on the instillation of 2 Xylocaine gels at 4°C into the urethra 15minutes before the procedure. The primary endpoint was the successful completion of the procedure without interruption due to pain or the need for any other form of anaesthesia or analgesia. RESULTS: Twenty-seven patients were included with a median age of 65 years and a prostate volume of 46mL. The International Prostate Symptom Score (IPSS) was 23. The first 3 patients were operated on under general anaesthesia. Local anaesthesia was introduced from the fourth patient onwards. There was no recourse to other modalities of analgesia or anaesthesia or interruption of the procedure. The operating time was 10minutes and pain was assessed at 1 on a visual analogue scale. At 3 months, the IPSS score was 9 (P=0.001). CONCLUSION: This preliminary experience confirms the feasibility of placing the Urolift implant under local anaesthesia without any failure of the proposed management. The improvement in IPSS score was consistent with previously published clinical trials. LEVEL OF EVIDENCE: 3.

[Comprehensive review of 3D printing use in medicine: Comparison with practical applications in urology]. / Revue compréhensive de l'apport de l'impression 3D en médecine : mise en perspective des différentes applications en urologie.

INTRODUCTION: Over the past few years, 3D printing has evolved rapidly. This has resulted in an increasing number of scientific publications reporting on the medical use of 3D printing. These applications can range from patient information, preoperative planning, education, or 3D printing of patient-specific surgical implants. The objective of this review was to give an overview of the different applications in urology and other disciplines based on a selection of publications. METHODS: In the current narrative review the Medline database was searched to identify all the related reports discussing the use of 3D printing in the medical field and more specifically in Urology. 3D printing applications were categorized so they could be searched more thoroughly within the Medline database. RESULTS: Three-dimensional printing can help improve pre-operative patient information, anatomy and medical trainee education. The 3D printed models may assist the surgeon in preoperative planning or become patient-specific surgical simulation models. In urology, kidney cancer surgery is the most concerned by 3D printing-related publications, for preoperative planning, but also for surgical simulation and surgical training. CONCLUSION: 3D printing has already proven useful in many medical applications, including urology, for patient information, education, pre-operative planning and surgical simulation. All areas of urology are involved and represented in the literature. Larger randomized controlled studies will certainly allow 3D printing to benefit patients in routine clinical practice.

Immediate preoperative renal artery embolization in the resection of complex renal tumors (UroCCR-48 Reinbol study).

PURPOSE: We evaluated the feasibility and outcomes of immediate preoperative renal artery embolization (IPRAE) before complex nephrectomy for locally advanced RCC ± inferior vena cava thrombus (IVCT). METHODS: A comparative retrospective (2007-2017) multicenter study which included 145 patients with locally advanced RCC ± IVCT: 99 radical nephrectomies vs. 46 radical nephrectomies with IPRAE identified in the prospective UroCCR national database (CNIL DR 2013-206; NCT03293563). IPRAE was performed under local anesthesia the day of nephrectomy (< 4 h prior to nephrectomy). The primary endpoint was peroperative blood loss (mL). Secondary outcomes were: tolerance of embolization (pain visual scale), success rate of IPRAE defined by complete devascularization of the kidney, perioperative complications according to Clavien score and postoperative GFR. RESULTS: The baseline characteristics of IPRAE and the control groups were similar. Tumor staging was 14% T2b, 41% T3a, 27% T3b, 13% T3c, 6% T4. The success rate of IPRAE was 98%. Median artery embolizated per patient was 2 (Agochukwu and Shuch in World J Urol 32:581-589, 2014; Marshall et al. in J Urol 139:1166-1172, 1988; Yap et al. in BJU Int 110:1283-1288, 2012;Gill et al. in J Urol. 194:929-938, 2015; Wang et al. in Eur Urol 69:1112-1119, 2016). No severe complications occurred after IPRAE. Postembolization syndrome was reported in 7% (Clavien I-II). Mean peroperative blood losses in the IPRAE and control groups were: 726 ± 118 ml and 1083 ± 114 ml (P = 0.03). In a multivariate analysis that included: age, Karnofsky index, IPRAE (yes vs. no), IVCT (yes vs. no), tumor size and synchronous metastasis, no IPRAE and IVCT were significantly associated with increased peroperative bleeding. CONCLUSION: IPRAE before nephrectomy for locally advanced and/or IVCT tumors was well tolerated, was associated with lower peroperative bleeding and did not increase the incidence or severity of postoperative complications.

[French ccAFU guidelines - update 2020-2022: management of kidney cancer]. / Recommandations françaises du Comité de cancérologie de l'AFU ­ actualisation 2020­2022 : prise en charge du cancer du rein.

OBJECTIVE: - To update the French guidelines on kidney cancer. METHODS: - A systematic review of the literature between 2015 and 2020 was performed. The most relevant articles regarding the diagnosis, the classification, surgical treatment, medical treatment and follow-up of kidney cancer were retrieved and included in the new guidelines. The guidelines were updated with corresponding levels of evidence. RESULTS: - Thoraco-abdominal CT scan with injection is the best radiological exam for the diagnosis of kidney cancer. MRI and contrast ultra-sound can be useful in some cases. Percutaneous biopsy is recommended when histological results will affect clinical decision. Renal tumours must be classified according to pTNM 2017 classification and ISUP grade. Metastatic kidney cancers must be classified according to IMDC criteria. Partial nephrectomy is the recommended treatment for T1a tumours and can be done through an open, laparoscopic or robotic access. T1b tumours can be treated by partial or total nephrectomy according to tumour complexity. Radical nephrectomy is the recommended treatment of advanced localized tumours. There is no recommended adjuvant treatment. In metastatic patients: cyto-reductive nephrectomy can be offered in case of good prognosis; medical treatment must be counseled first in case of intermediate or bad prognosis. Surgical or local treatment of metastases should be considered in case of solitary lesion or oligo-metastases. First line recommended drugs in metastatic patients include the associations axitinib/pembrolizumab and nivolumab/ipilimumab. Cystic tumours must be classified according to Bosniak Classification. Surgical excision should be offered to patients with Bosniak III and IV lesions. It is recommended to follow patients clinically and with imaging according to tumour aggressiveness. CONCLUSION: - These updated recommendations should assist French speaking urologists for their management of kidney cancers.

[Use of personalized 3D printed kidney models for partial nephrectomy]. / Utilisation de l'impression 3D avant néphrectomie partielle pour tumeur du rein.

Partial nephrectomy is a first-line treatment option for the management of renal tumors. It is a surgical procedure whose complexity and stakes vary according to the specific anatomy of the patient and his tumor. 3D modeling and 3D printing have become a means of representing and thus visualizing the tumor lesion and its anatomical relationships within the organ. This mode of visualization allows the surgeon and his team, but also the patient, to easily realize the tumor complexity, the predictable difficulty of the surgery and therefore the risks of complications. Various publications have reported the benefit to the patient in terms of pre-therapy education. Some have shown a benefit for the operator in terms of surgical planning. Finally, studies on preoperative surgical simulation showed shorter kidney lumpectomy times and less bleeding when surgeons were able to train before the operation on the corresponding 3D printed model. 3D printing therefore represents an innovative tool that would improve patient management prior to partial nephrectomy, through the information it can deliver, but also through surgical simulation.

Is recipient's body mass index a determinant of short term complications in early renal transplantation?

OBJECTIVES: Obesity prevalence has increased over the past 20 years in the general population and among kidney transplant recipients. General surgical belief is that obesity increases surgical difficulty. The aim of this study was to assess the impact of Body Mass Index (BMI) on perioperative complications. METHODS: All kidney transplantations performed in adults in our centre from 2006 to 2011 were analysed. Data on patients' characteristics, surgical protocol, intra and postoperative complications and renal function were collected. Patients were divided into 4 groups as follows: underweight (BMI<18.5kg/m2), normal weight (18.5kg/m2≤BMI<25kg/m2), overweight (25kg/m2≤BMI<30kg/m2) and obese (BMI≥30kg/m2). We also studied the impact of BMI on complications using it as a continuous variable to identify potential threshold values. RESULTS: Among 694 patients included, 52% had normal BMI, 7%, 31% and 9% were underweight, overweight and obese, respectively. In multivariate analysis, overweight was significantly associated with longer operative time compared to normal-weight patients (estimated mean difference of 10,4min, 95% confidence interval (CI) [4.0; 16.9]) and obesity was associated with an increased risk of wound dehiscence (odds ratio 3.1, 95%CI [1.3; 7.3] compared with normal-weight patients). Considering BMI as a continuous variable, the risk of parietal dehiscence significantly increased beyond a BMI of 26kg/m2, intraoperative blood loss and the risk of ureteral stenosis beyond 32kg/m2 and the risk of abdominal wall hematoma beyond a BMI of 34kg/m2. CONCLUSIONS: We found BMI thresholds above which intraoperative blood loss and the risk of parietal dehiscence, ureteral stenosis, and parietal hematoma significantly increased. LEVEL OF EVIDENCE: 3.

[Predictive factors of active surveillance interruption for prostate cancer after 5years of follow-up]. / Surveillance active du cancer de prostate : facteurs prédictifs d'échecs après 5 ans de suivi.

INTRODUCTION AND PURPOSE: The objective of this work was to identify the risk factors (RFs) of active surveillance (AS) interruption in a prostate cancer (PCa) single-center retrospective cohort of patients. MATERIAL AND METHOD: All patients in AS between January 2011 and October 2019 were retrospectively included in a computerized database. The group of patients who had an AS interruption was compared to the one still under AS, in order to identify potential risk factors for the interruption of the surveillance protocol. RESULTS: Two hundred and two patients have been included in the AS cohort with a median follow-up of 32months. At the time of analysis, 72 patients (36%) were not under the AS protocol anymore, 118 (58%) were still under AS and 12 (6%) were lost of follow-up. Sixty-six patients (92%) had left SA due to PCa progression, 4 (5%) by personal choice and 2 (3%) switched to watchful waiting. A PSA doubling Time<3years (PSADT<3years) has been identified as the only statistically significant RF for AS interruption, both in the unvaried (P<0.001) and multivariate (OR=5.403, P<0.01) analysis. It was also the only RF of AS interruption in the early analysis in the first three years of AS, in the unvaried analysis (P=0.021) and the multivariate analysis (OR=3.612, P=0.018). CONCLUSION: PSADT was the only RF of AS early and late interruption in our study. It represents a major inclusion criterion in AS protocol during the initial assessment. LEVEL OF EVIDENCE: 3.

Active surveillance in prostate cancer is possible for Afro-Caribbean population: Comparison of oncological outcomes with a Caucasian cohort.

BACKGROUND: Prostate cancer is supposedly more aggressive among Afro-Caribbean men. There is a lack of data in this population for active surveillance. Published series are retrospective or have small samples and results are discordant. The objective was to determinate whether actual active surveillance modalities can be applied for Afro-Caribbean men by comparing their oncological outcomes with Caucasian men. METHODS: A total of 449 consecutive patients who underwent active surveillance for favorable-risk prostate cancer in two French University-Medical-Centers between 2005 and 2018: 261 in Guadeloupe, French West Indies, and 188 in Bordeaux, metropolitan France. Median follow-up was 56 months, (95% CI [32-81]) and 52 months (95% CI [30-75]), respectively (P=0.07). Curative treatment was given in case of histological, biological, or imaging progression, or upon patient demand. Primary endpoints were treatment-free, overall and specific survival. Secondary outcomes were reasons of discontinuating active surveillance, histological poor prognosis factors after prostatectomy, CAPRA-S score, biochemical-recurrence-free after treatment and metastasis-free survival. Kaplan-Meier method was used. RESULTS: Median treatment free survival was 58.4 months (CI 95% [48.6-83.1]) for ACM and not reached at 120 months for CM (P=0.002). Overall survival (P=0.53), and specific survival (P=0.21) were similar in the two groups. CM were likely to have poor prognosis factor on prostatecomy piece (57 vs 30%, P=0.01). No difference for repartition of the CAPRA-S score (P=0.86), biochemical-recurrence-free (P=0.92) and metastasis-free (P=0.44) survival. CONCLUSIONS: Oncological outcomes for active surveillance of Afro-Caribbean and Caucasian men were similar in terms of mortality, recurrence and metastasis in our bicentric study, showing usability of current criteria for Afro-Caribbean. The higher rate of disease progression in the Afro-Caribbean population requires close monitoring. LEVEL OF EVIDENCE: 3.

[The basis of endoscopic stones recognition, a prospective monocentric study]. / Base pédagogique de la reconnaissance endoscopique des calculs, étude prospective monocentrique.

INTRODUCTION: To evaluate by junior urologists the morphology of urinary stone using visual endoscopic recognition after expert teaching. Material From December 2017 to May 2018, surface and section stone pictures extracted from digital ureteroscopy had been submitted to description and recognition. Participants could take benefit from an expert coaching. Each stone was evaluated by a different coherence questionnaire (score 1-5). RESULTS: Nine stones had been analyzed by 15 junior urologists. Mean score was initially 1.94/4 and then from 2.07 to 4.07/5 during the study. A perfect stone recognition and a matching etiological lithiasis research had been observed in 40.7% and 55.6% of cases respectively. CONCLUSION: This first teaching experience of the urinary stone morphological endoscopic typing confirms the possibility to train urologists to gain this specific initial skill. Thereby, they could play a more important role in the etiological and diagnostic lithiasis research.

Measurement of the Accuracy of 3D-Printed Medical Models to Be Used for Robot-Assisted Partial Nephrectomy.

OBJECTIVE. Three-dimensional printing is being used for surgical assistance, particularly for robot-assisted partial nephrectomy (RAPN). The objective of this study was to assess the anatomic accuracy of the 3D model used for 3D model-guided RAPN. SUBJECTS AND METHODS. The study included patients who underwent RAPN aided by 3D printing and anonymized CT. The model, based on preoperative CT with specialized software and a 3D printer, included vascular, urinary, parenchymal, and tumoral elements. It was then scanned. The major axis of the kidney and tumor and the volume of the tumor were measured blindly on the preoperative CT scan and the CT scan of the 3D model. Three comparative measurements between arterial branches were performed for each patient. The correlation of the arterial distribution between the scanner and the 3D model was evaluated on a Likert scale. RESULTS. A total of 16 patients were included between December 2017 and March 2018. The median tumor size was 4.7 cm (interquartile range [IQR], 3.9-6.5 cm). Between the initial CT scan and the 3D printed kidney, the major renal axis varied a median of 1.8% (IQR, 0.8-4.23%), major tumor axis varied 2.35% (IQR, 0.45-8.6%), and the tumor volume varied 14.7% (IQR, 11.5-25.2%). The median arterial interbranch measurement (three measurements performed on each kidney) was 1.8% (IQR, 1-3.25%). Fourteen of 16 (87.5%) 3D printed models had a score of 4 or higher by two readers and were considered valid. CONCLUSION. Three-dimensional printed models are accurate with respect to anatomic reality. The reliability of surgical assistance with 3D printed models must be evaluated.

Long-term oncological outcomes of cystic renal cell carcinoma according to the Bosniak classification.

OBJECTIVES: To evaluate the prognostic role of the Bosniak classification on the long-term oncological outcomes of cystic renal cell carcinomas. MATERIAL AND METHOD: In a national multicentric retrospective study, we included patients treated surgically for localized cystic RCC from 2000 to 2010. Patients with a follow-up of less than 4 years, benign tumors, and ablative treatments were excluded. The primary outcome was disease-free survival. RESULTS: 152 patients met the inclusion criteria: Bosniak II (6%), III (53%), IV (41%), with a median follow-up of 61 (12-179) months. Characteristics of the population and the tumors were [median, (min-max)] age 57 (25-84) years old, tumor size 43 mm (20-280), RENAL score 7 (4-12), PADUA score 8 (5-14). Treatments were 55% partial nephrectomy, 45% radical nephrectomy, 74% open surgery, and 26% laparoscopy. In pathological report, cystic RCC were mainly of low grade (1-2, 77%) and low stage (pT1, 81%). The two main histological subtypes were conventional (56%) and papillary (23%) RCC. Staging at presentation and histological characteristics were similar between Bosniak III and IV, except for high grade which was more common in Bosniak IV (12 vs 36%, p < 0.01). The Bosniak classification was not predictive of the recurrence, as 5- and 10-year disease-free survival were similar in Bosniak III and IV (92% vs 92% and 84% vs 83%, p = 0.60). CONCLUSION: The Bosniak classification is predictive of the risk of malignancy but not of the oncological prognosis. Regardless of the initial Bosniak categories, almost all cystic RCCs were of low stage/grade and had low long-term recurrence rate.

Who is dying after nephrectomy for cancer? Study of risk factors and causes of death after analyzing morbidity and mortality reviews (UroCCR-33 study).

BACKGROUND AND METHODS: Nephrectomy is the treatment for renal cell cancer from T1-4 tumors but remains at risk. To determine the thirty-day mortality rate after nephrectomy for cancer and to identify causes and risk factors of death in order to find clinical applications. From 2014 to 2017, we performed a retrospective multicentric analysis of prospectively collected data study involving the French network for research on kidney cancer (UroCCR). All patients who died after nephrectomy for cancer during the first thirty days were identified. Patients' characteristics, causes of death and morbidity and mortality reviews reports were analyzed for each death. RESULTS AND LIMITATIONS: In total, 2578 patients underwent nephrectomy and 35 deaths occurred. The thirty-day mortality rate was 1.4%. In univariate analysis, symptoms at diagnosis (P=0.006, OR=2.56 IC (1.3-5.03)), c stage superior to cT1 (P<0.0001, OR=6.13 IC (2.8-13.2)), cT stage superior to cT2 (P<0.0001, OR=8.8 IC (4.39-17.8)), nodal invasion (P<0.0001, OR=4.6 IC (1.9-10.7)), distant metastasis (P=0.001, OR=4.01 IC (1.7-8.9)), open surgery (P<0.0001, OR=0.272 IC (0.13-0.54)) and radical nephrectomy (P=0.007, OR=2.737 IC (1.3-5.7)) were risk factors of thirty-day mortality. In a multivariable model, only cT stage superior to T2 (P=0.015, OR=3.55 IC (1.27-10.01)) was a risk factor of thirty-day mortality. The main cause of postoperative death was pulmonary (n=15; 43%). The second cause was postoperative digestive sepsis for 7 patients (20%). Only 2 morbidity and mortality reviews had been done for the 35 deaths. Limitations are related to the thirty-day mortality criteria and descriptive study design. CONCLUSIONS: Symptomatic patients, stage cTNM and type and techniques of surgery are determinants of thirty-day mortality after nephrectomy for cancer. The first cause of postoperative death is pulmonary. Morbidity and mortality reviews should be considered to better understand causes of death and to reduce early mortality after nephrectomy for cancer. LEVEL OF EVIDENCE: 4.

RETRACTED: Recommandations françaises du Comité de Cancérologie de l'AFU ­ Actualisation 2018­2020 : prise en charge du cancer du reinFrench ccAFU guidelines ­ Update 2018­2020: Management of kidney cancer / Recommandations françaises du Comité de Cancérologie de l'AFU ­ Actualisation 2018­2020 : prise en charge du cancer du rein.

This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). Cet article est retiré de la publication à la demande des auteurs car ils ont apporté des modifications significatives sur des points scientifiques après la publication de la première version des recommandations. Le nouvel article est disponible à cette adresse: DOI:10.1016/j.purol.2019.01.004. C'est cette nouvelle version qui doit être utilisée pour citer l'article. This article has been retracted at the request of the authors, as it is not based on the definitive version of the text because some scientific data has been corrected since the first issue was published. The replacement has been published at the DOI:10.1016/j.purol.2019.01.004. That newer version of the text should be used when citing the article.

[Partial nephrectomy for renal masses >7cm: Morbidity, oncological and functional outcomes (UroCCR-7 study)]. / Néphrectomie partielle pour tumeur de plus de 7cm : morbidité, résultats oncologiques et fonctionnels (UroCCR-7 study).

OBJECTIVES: To describe the morbidity, mortality, oncological and functional results of Partial nephrectomy (PN) for the treatment of renal tumors of more than 7cm. MATERIAL AND METHODS: Thirty-seven partial nephrectomies for tumors larger than 7cm operated in a single center between 1987 and 2016 were analyzed retrospectively. The pre, per and postoperative clinico-biological data were collected within the UroCCR database. The GFR was assessed at day 5, 1 month and last follow-up. Intraoperative and postoperative surgical complications, the recurrence rate and the overall and specific mortality were collected. RESULTS: The mean age of the patients was 57 years (44-68). The preoperative GFR and the median tumor size were 80mL/min and 8cm, respectively. The indication for surgery was elective in 21 cases (60%) and 19 tumors (54%) were malignant. Postoperative complications occurred in 24,3 cases (24.3%). The median post-operative GFR was respectively 77mL/min, 80mL/min and 77mL/min at day 5, 1month and at last follow-up. With a median follow up of 31 months [1-168], 5 patients (26,3%) had metastatic progression of whom 1 (5.3%) had a concomitant local recurrence and 3 (15.8%) had died from cancer. CONCLUSION: This study confirms the feasibility of PN for large tumors with acceptable morbidity, limited risk of local recurrence and excellent functional results. LEVEL OF EVIDENCE: 4.